Interfaces and interactions – who controls technology for dementia?

Reading through the publications I analyse on technology and dementia I found many interesting and contrasting accounts on ‘interaction’. In this post I collect some initial views and will not be able to cover the topic in total as I am aware that there are still publications covering this topic that need to be indexed. But I hope to get an insight into different themes emerging by writing at this stage.

Cahill (2007, 58) categorise products as follows:

“The technologies can be categorised as follows:
– Devices that are operated by the person (radio, TV, (mobile) telephone, car);
– Systems and devices that others have installed and maintain, but which the person uses (electricity, water supply system, air condition);
– Monitoring and surveillance systems and devices which are either:
∗ activated by the user (safety alarms);
∗ activated automatically when an incident occurs (fire alarm, fall alarm);
∗ monitors continuously or when the operator decides (cameras installed at public places, tagging devices).
Obviously, when the person with dementia has an active role in handling the assistive technology, due considerations to the clinical symptoms must be taken.”

So far I see three themes emerging, depending on the level of interaction required to use a product: Minimal user interaction, use by the caregiver and digital inclusion.

Minimal user interaction is the topic around smart technologies, automatic prompting and health monitoring. I became aware of this approach first, when reading about a project using a smartphone to monitor health-related data of people living with dementia at home. Boletsis, McCallum and Landmark (2015, 19) selected a smartwatch “whose full functionality does not require any interaction, apart from charging it, once every 3 days.” From this it becomes clear that this is a technology to be used ‘on’ people with dementia, rather than ‘by’ them. Skillen (2012, 6391) discuss the advantage of “minimal user interaction” that a product can  “subsequently offer assistance when required.” Boger (2006, 324) even go further than this and declare an technology only successful if it works autonomously:

“If they are to be effective, devices aimed at aiding people with dementia must be able to operate autonomously, without any explicit feedback from the care recipient or the caregiver.”

Marilyn Cash (2003, 313) gives an explanation for this approach:

“One of the key characteristics of this set of technologies is that many of them are passive and do not require the person with dementia to remember what they are or how to use them.”

Astell (2006, 16) holds a different view and warns that:

“The use of assistive technology highlights the delicate balance between supporting people with  dementia to remain as independent as possible and dehumanising them by taking over their activities.”

Ancient and Good (2014, 114) share this view and extend it to the concept of care: “It is important to note, that when assistive technology is introduced it should aim to augment the daily caring activities, rather than replace them totally.”

Alm (2009, 198) add the interesting insight that mastery also plays a role in engaging users with dementia, which in my opinion points towards a more reciprocal mode of interaction: “Having a ‘mastery’ aspect to activities was helpful even for people with working memory problems.”

As an Interaction Designer I am inheritently interested in the joint between humans and technology and the tension that Astell describes. As a result I will focus on technology that interacts with the user in a reciprocal way. I will explore Smart Technologies and Automatic Prompting Systems further, but only in regards to the way prompts are issued.

One exeption will be my ongoing examination of developments in regards to monitoring and surveillance. Even though they lack in interactions completely at the moment, I am interested whether there are ways in which to incorporate them.

Some of the technologies developed address the caregiver as the user of the device or technology. This is only mentioned in passing here, as the relationship between people living with dementia, their caregivers and technology will be explored further in another blog entry.

In addition to presenting the automatic technology, I want to present the alternative view as well, that people living with dementia can benefit from software that caters to their needs and understandings. Peterson (2009, 2) warns that people living with dementia may not have full access to technology so far: “Unfortunately, when it comes to older adults’ computer usage, they fall into the digital divide, those with dementia certainly fall into the disability gap as well.”

The work by Claire Ancient and Alice Good is specifically important in this regard. They acknowledge both the possible uses of technology for people with dementia as well as the limitations faced at the moment:

“By not considering the interaction needs of people living with dementia, interface designers may be isolating their intended users and hence negating the potential effectiveness of the developed technology. This could lead to prospective users disregarding a technology which could enhance their quality of life, enabling them to remain within the community and increase their safety.” (Ancient; Good, 2014, 114)

They further analysed screen-based interfaces and how people with dementia interacted with them to develop specific guidelines.  (compare Ancient; Good, 2011)

While reading on about technology and dementia one further theme emerged: design for interaction with a partner. Wallace (2012, 2637) identified this as one of the uses emerging from their art piece:

“Design needs to promote more reciprocal conversations in which clients can contribute their knowledge and share their expertise with staff. Through self-disclosure of personal information a client opens the space for staff to give an empathic response and value the person for who they are.”

A similiar result has been found by Astell (2010, 274), who also give a positive result from this type of interaction:

“In summary the findings of the present study suggest that CIRCA can change the situation of people with dementia and caregivers to improve their relationship. Joint attention can play a key role in interactions between people with dementia and caregivers by promoting scaffolding behaviour in the caregiver. This empowers the person with dementia and redresses the status hierarchy during the course of the interaction.”

Leaving out the tension of who is  the user of technology – someone with dementia or the people next to them – three interesting themes emerge that can be set in contaxt with other views on dementia. ‘Invisble’ automatic technology follows the biomedical view on dementia that sees people living with dementia in the context of loss of abilities and consider technology as a way to counteract this. In this view technology often takes on tasks currently done by human caregivers and replaces them with technological solution.

Calls for more inclusive (web) technologies see dementia in the context of disabilities and aim to alter development structures to make sure that people living with dementia have the same access to technology as they used to have before or as others not affected by the illness.

Some development projects pose questions about selfhood and a more engaging, exploratory use of technology as the last quote for example shows.




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